01050163 4s
-,CITY QF CUPERTINQ,
nun tone mvtston r CONTRACTOR INFORMATION:f;
'
PERMITd l.,. .. :
BUILDING ADDRESS: ' PERMIT NO
1.8750 BARNHARDT. AVENUE,` COSMOS ,ROOF"T'hIG rs :-.1010501-63.
OWNER'S NAME. } APPLICATION SOB DAI I
SMT^TH :. hANELI ft50 :wiSANwAhI I"DI�lCI A)7 r v rro,-:VJkl-�cnc'!';c00:1'*.,.
HONE:. _ i SANITARY NO. - CONTROL NO.
• .. k � ' .w � "°•.ia=(:4n1,5�-�I;�.u^wt+�JC�+,t7.+9g2„r• ,
K Z AliClll'I'F.CT/ENGINEEH: BUILDING PERMIT INFO
O O t BLDG ELECT PLUMB MECfi
Z F Z LICI NSFD CONTRACTORS Ill CI ARATION - Job Description
.'
O o Ih by ffrnthatI licensed d p or chapter 9( 6
OZ y with Swl nn 7(1(IOIofD 31theB dPrfu, ,nx Codc andny l - - a �.
aY .'nrallRne• ,�kelr . . ,gTGfa,R,Tl7k-'F_' „I�(;,RmANRC%Rlt,1^, VELeIa.; ADU,rts1;AR�,.AND G
5a IJecnse -
aMi O e Dole C tinct -
trl 3 t< ARCHITECT'S DECLARATIO -
C� I d .I 1 YN 'shall he 'e”
I p bl'mcoMs
OWNER BUILDER DECLARATION _ _
Ei I hereby union that I a n eveopt from the Co ur et r s Licri L for the `
9011.50 .' dP f.' Cd Ay cig bweaunly , ✓ - - - '
F❑ whd,bacteers ooautto to ure, h p le hd,ar,ar an,o I , -
3_
prior tits :. I c the applicantf pe
h
that hI Ip t in the provisions oft Contructor's License Ia (Chapter 9 �Sq. Ft. Floor Area Valuation
(cnm g +thS I 700(4 fDl t3 of 11u,B .' dP eel :Care)
it that he I,rten,o thercfn n and the basis birdie alleged toceniptior.Any violation • -
of Section 70315 by try+pplcant for a perant. bjeets the 1plic to a civil penalty
if ,t nowman t ve n t tdred Jena„(8500). APN,Number " - " ? Occupancy,Type
°1 nn P ,111 r ply with ge Ha I p t' -?7527
.171 1- .elo ,.
-
will do the k I,h r -t 's net' tender or offervilfr:al (SrrL70,4 r _ y, -'
"B and Proresi ne Code The C+ , mo L s cense Law acs not apply an an - Required Inspections
fprooc,t,Who h Id:or br,pontr,,n - and whoduc,, ch workh If �T Y-T5PAME
ter through h. p1Y .D Jdmt. n' p t ,wtnJd 'J1 Lt YlSe r._q ,
1 -
offered for sale.If,h theraining P l ld withina Ye f -a
nmplel m the ownerhudderw'E have Wehrrden or provingthad he Aid nlbrtid it ., _ I15154(h'.�A IOnI�';-a
ilnprove e,r pmtace r I .t. dxROOFarw7EAR,. OFF.
of a5co terbfthe, my, Its ly lindualtial withl'en d r6unictias1. _ 602 ROOF,:: PLYWOOD 'NATI�"'v , -
conduct the protect(Set,7044 Bush and Professions C1deJ The Contractor s _. a b.. .��. rdR`
L ornce Law does not apply I wn r ofpropeny is he b Ids improves thereon, - q
,cid n < n et. I 1 projects win „cmr(c)1 . d p :torn t theROOF=•aBATTIE�IS)q run t : FfP4 ,:. .ROOF lPl-;PROGRESS =rr.
°1 eni,orde Stt. .BR PC fee e - - '
Owner ex ..Date i' r • +
WORKER'S COMPENSATION DECLARATION v
I herehy nlBim under penalty of perjury one of the following deelawtinns.' -
❑ I have and will,abortion a Cerfifiane of Consent to wlf-insure for,Worker's -
Citur,cretion, a, provided for by Section 9700 f the Labor Qd f th ,
ftn 1, I'hthi:prtlo,t d -' - •EINALED _
- -�I haveaad will mtmi.Wrk C p i 1 yuiwdbyS ion
,M of,hc Lobo Code,'ft r the perf un anw of the work for which thin peord,is - q -
ix B My W'ke, Co 1pe ls.I on ltw and Policy inn be,are .� MAY, 2 9 2001 - -
C . ��PI'Y N ._IL dO�II
CEKI'I FICATION OF EXEMPTION FROM WORKERS -
COMPENSATIONINSUHANCF + BUILDING "
('Ihit- I ni rend ant be er np rt d iffla,permit is I shundred drllaw
'v ($100),,lens) - - -
I ecify thus in the pi,ff etureee of the work for which thin tenni,is iAt1rd,
hot] I.roplo,a.,t : Y1f r so o,an hweuhlec,in We Workers' _
C pnsairtLws orCulilooda,Ddit
Applicant
NOTICE TOAPPLICANT:If,after making,bis Cenificate of Exemption.you should
ho,aric abi,t, due W k C.ni,abnownt i r 'i:iig,dt de,Labor Code undoid ' - • ��
Q
forthwith a nply with such tr.,,ion,or the Peru,,stall bedeemetl worked.
F 4 CONSTRUCTION LENDING AGENCY ,.
I hereby affr that there'. curst i leading agency for the perform _ -
of the work for which this per n t iss
'med(Sec.3097,Cb.C.) -
S Q Lender's Name-
o-z L J :Add
_ V Iecrt fythallh�ve rwAtlisappl' ion and state tht the:bmenfnrna,ien
W LPycr I in.In nply withall a, d county r luenteec and state laws relating - -
0,U •to btldng consducfot and hereby authorize representatives oflhs city in emcrupnt
yJtheb y n i ed property f p cit e......
k, IW7 grct i
'fy Ikeep l I::Ih City fCprt' against
SOURCE REGULATIONS. cid expe is 1 Yvn a against cad
'n any way y
G
V
'City sequence f the brown Part cit -
APPLICANCUNDERSTANDS DWUr,COMPU, 'il'HALLNON DINTD Issued by: � � Date
S
signantre rrnppueanVeontrnrtur - - Done If Re-roofs '
.HAZARDOUS M TC RIALS DISCLOSURF - -
Will me a,fiant or future l a ldirg occo,ard nmrcar haeme LasNau.'dialectal' Type of Roof.. '. . .
_ as define)by On,Cdpenino Mnniclpul Code,Chapter 9,C!,and the Health and Safety ,
Code.Section 25532(r)7,
` - °Yes All roofs shall be inspected prior46 any roofing material being installed:''- '
Will th pnI'- l r to building p' t eq '� t 1 which If a roof is installed without first obtaining'airinspection;I agree to remove •
tTI Morn irc+ ,am'nm:aden dby me Bay An.A Quality Management
a+ all new materials for inspection. Applicant understands'and will comply with
'pY r - alllnon-point source regulations. -
I h I the Intuitions n I y tv 6rder Chapter fi 95 of,h - -+
C.1inare.Health kSurety Code Section,2550525533 ad255341 arderibardtht
if th h 'Id bd dytr ,e ,t6mJ : y t bfyl l ,fyIh ; '� t.. :�✓ �/�. ,� .
Ocutuntofthe r'f emenr,which nus,Ire mut Priorm aneofdC iteIn1f F
_ a ,q
Signature dApplica t , , Date- .
-' 'All roof coveiin s to be Class,"Bi' or better
ownerorawhrded - . Dale g "
- .. OFFICE. ,